Chronic Kidney Disease Hemodialysis Research Articles

Comparison of Factors Affecting the Immune Response to Hepatitis B Vaccination in Patients with Stage 5 Chronic Kidney Disease-haemodialysis and Predialysis

Aim To evaluate the factors that affect the immune response to Hepatitis B vaccination in the Stage 5 chronic kidney disease population (Haemodialysis and Predialysis). Methods Eligible Stage 5 chronic kidney disease patients on haemodialysis (Cohort A: N= 39) and Predialysis (Cohort B: N=56) in an outer metropolitan renal service in Western Australia with no prior Hepatitis B infection or vaccination between Jan 2015 to Dec 2021 were involved in this retrospective cohort study. Serological response to Hepatitis B vaccination (H-B-VAX II 40 mcg intramuscularly at 0, 1 and 6 months) was evaluated six-eight weeks post-vaccination. Factors such as age, gender, diabetes mellites, cardiovascular disease, hypertension, chronic obstructive airway disease, serum albumin, and erythropoietin stimulating agent dependence were studied for their influence on immune responses in these cohorts. Results There were 95 eligible respondents in the study. Cohort B (Predialysis) showed a significantly higher response than Cohort A (Haemodialysis) (66.1% vs 53.8%) (p=0.003). Different factors affecting the vaccine response were identified in the two cohorts. Serum albumin <35g/L was associated with negative response in 61.1% (p =0.0023)Cohort A HD patients. In the Predialysis Cohort B, 84.2%(p=0.026) were male gender, 63.2%(p=0.028) with the presence of cardiovascular disease, and 57.9%(p=0.001) who were Erythropoietin dependent showed a negative response to the vaccine. Conclusion This study showed that the Hepatitis B vaccine response was lower in HD patients than in Predialysis patients with stage 5 chronic kidney disease. Clinical factors of serum albumin, cardiovascular disease, and patient factors of gender and erythropoietin dependence were identified as factors that affected vaccine response in these two cohorts. We postulate these factors to be considered in the hepatitis B vaccination management to enhance immunological response strategies and extend to earlier stages of chronic kidney failure.

Effect of single hemodialysis session on inflammatory and oxidative stress markers of chronic kidney disease patients

Background: Chronic kidney disease (CKD), with its high prevalence, morbidity and mortality, is an important public health problem. The progression of CKD has been shown to result in inflammation and oxidative stress. For CKD hemodialysis (HD) is the most common RRT modality in India. Present study aimed to compare and evaluate the immune modality profile, oxidative marker and biochemical profile of pre and post dialysis chronic kidney disease patients. Material and method: The study included 40 CKD patients depending on inclusion and exclusion criteria, attending HAHC hospital, HIMSR, New Delhi, which were on hemodialysis. The mean age of the patient was 60±15 yrs. Patients undergoing dialysis thrice in a week for about 4 hrs per session at flow 250-300 ml/min. Inflammatory and oxidative stress markers were assessed pre and post dialysis during any one session of dialysis in chronic kidney disease patients. Result: There was significant decrease in inflammatory and oxidative stress markers after dialysis. There was also significant decrease in biochemical marker levels post dialysis. Conclusion: Hence, evident from this study improvement in inflammatory markers and renal function test after dialysis suggests that indeed haemodialysis is the most common and better treatment option for chronic kidney disease patients.

A Questionnaire Survey of Prescription Preferences and Leftover Medication Conversations: Comparisons Among Kidney Disease Patients and Healthcare Professionals.

Patients with chronic kidney disease (CKD) and patients with kidney failure receiving hemodialysis (HD) receive various types of medications. However, little is known about the differences in medication preference and how to deal with leftover medication among CKD patients and HD patients. The purpose of this study was to investigate the differences in medication preference and ways of dealing with leftover medication between CKD patients, HD patients, physicians, and pharmacists via a questionnaire survey. The ethics committee of Oita University, Oita, Japan, approved this survey. Outpatients undergoing treatment by a nephrologist in four facilities in Oita prefecture, Japan, were asked to answer a questionnaire on their preference for medication and how to deal with leftover medication. Respondents gave their informed written consent. The same questionnaire was administered to nephrologists and pharmacists online. In this survey, 383 patients (260 patients with CKD and 123 patients with HD), 22 nephrologists, and 28 pharmacists responded. The response rate of valid responses was more than 90% for each of the groups. In particular, 41% of patients with CKD and 56% of patients with HD never inform their doctor about leftover medication or only inform them when there is a lot of leftover medication. On the other hand, 23% of physicians have never asked their patients about them. Ordinary logistic regression analysis indicated that there is no significant relationship between how often patients talk about leftover medication, patients' preferences, or patient states. Despite the age and state of the patients, it is important to discuss the perception of medication with each other and confirm the condition of the remaining medication to improve concordance and obtain the desired treatment effect.

Changes of Gut Microbiota in Maintenance Hemodialysis Patients and Their Impact on Patient's Microinflammation Status.

This study was to investigate the changes in gut microbiota in maintenance hemodialysis patients and analyze their impact on patient's microinflammation status. For this purpose, thirty-nine chronic kidney disease (CKD) maintenance hemodialysis patients admitted to our hospital from March 2019 to March 2022 were selected as the experimental group, and 40 healthy individuals with examination results during the same period were selected as the control group. The levels of gut microbiota (Lactobacillus, Bifidobacterium, Escherichia coli, and Enterococcus faecalis) and microinflammation indicators [interleukin-6 (IL-6), tumor necrosis factor α (TNF-α), and high-sensitivity C-reactive protein (hs-CRP)] were measured in both groups. The relationship between changes in gut microbiota and microinflammation in maintenance hemodialysis CKD patients was analyzed. Results showed that the levels of Lactobacillus and Bifidobacterium in the experimental group were significantly lower than those in the control group (all, P<0.05), while the levels of Escherichia coli and Enterococcus faecalis in the experimental group were significantly higher than those in the control group (all, P<0.05). The IL-6, TNF-α, and hs-CRP levels in the experimental group were significantly higher than those in the control group (all, P<0.05). Using microinflammation indicators as dependent variables and microbiota indicators as independent variables for stepwise regression analysis, the results showed that the levels of Lactobacillus were negatively correlated with IL-6 and TNF-α levels in patients (r=-0.358, -0.942, P<0.05); the levels of Bifidobacterium were negatively correlated with IL-6, TNF-α, and hs-CRP levels in patients (r=-0.394, -0.211, -0.547, P<0.05); the levels of Escherichia coli were positively correlated with IL-6 and TNF-α levels in patients (r=0.221, 0.268, P<0.05); the levels of Enterococcus faecalis were positively correlated with IL-6 and hs-CRP levels in patients (r=0.253, 0.378, P<0.05). In conclusion, patients with maintenance hemodialysis for CKD commonly exhibit gut microbiota dysbiosis and varying degrees of low-grade inflammation. Compared to healthy individuals, maintenance hemodialysis patients with CKD have lower levels of Bifidobacterium and Lactobacillus and higher levels of Escherichia coli and Enterococcus in their gut. Bifidobacterium, Lactobacillus, Escherichia coli, and Enterococcus all have a certain impact on the low-grade inflammation status of patients with maintenance hemodialysis for CKD.

Management of Immature Arteriovenous Fistulas.

In patients requiring long-term hemodialysis for chronic kidney disease, an arteriovenous fistula is the preferred mode of hemodialysis access over synthetic arteriovenous graft or hemodialysis catheters. The National Kidney Foundation recommended in their Kidney Dialysis Outcomes Quality Initiative (KDOQI) Clinical Practice Guidelines that the creation of an autogenous arteriovenous fistula should initially be sought whenever possible. In 2003, a program named the Fistula First Breakthrough Initiative was initiated in the U.S. to increase the use of arteriovenous fistula for hemodialysis and to ultimately surpass the goal of 50% fistula use in incident and 40% fistula use in prevalent hemodialysis patients per recommendation by KDOQI Guidelines. While this goal was achieved, the encouraged creation of arteriovenous fistulas saw a rise in fistulas that failed to mature. Researchers have focused on developing strategies to optimize fistula maturation. Studies have revealed that the presence of stenoses and accessory draining veins may contribute to unsuccessful fistula maturation. Endovascular treatment, including balloon angioplasty and accessory vein embolization, aim to correct anatomical factors that negatively affect the maturation process. This article reviews the techniques and outcomes of endovascular treatment in the management of immature fistulas.

The PPAR-γ Agonist Pioglitazone Modulates Proliferation and Migration in HUVEC, HAOSMC and Human Arteriovenous Fistula-Derived Cells.

The failure of arteriovenous fistulas (AVFs) following intimal hyperplasia (IH) increases morbidity and mortality rates in patients undergoing hemodialysis for chronic kidney disease. The peroxisome-proliferator associated receptor (PPAR-γ) may be a therapeutic target in IH regulation. In the present study, we investigated PPAR-γ expression and tested the effect of pioglitazone, a PPAR-γ agonist, in different cell types involved in IH. As cell models, we used Human Endothelial Umbilical Vein Cells (HUVEC), Human Aortic Smooth Muscle Cells (HAOSMC), and AVF cells (AVFCs) isolated from (i) normal veins collected at the first AVF establishment (T0), and (ii) failed AVF with IH (T1). PPAR-γ was downregulated in AVF T1 tissues and cells, in comparison to T0 group. HUVEC, HAOSMC, and AVFC (T0 and T1) proliferation and migration were analyzed after pioglitazone administration, alone or in combination with the PPAR-γ inhibitor, GW9662. Pioglitazone negatively regulated HUVEC and HAOSMC proliferation and migration. The effect was antagonized by GW9662. These data were confirmed in AVFCs T1, where pioglitazone induced PPAR-γ expression and downregulated the invasive genes SLUG, MMP-9, and VIMENTIN. In summary, PPAR-γ modulation may represent a promising strategy to reduce the AVF failure risk by modulating cell proliferation and migration.

A case of diffuse idiopathic hyperostosis of bone (DISH) in a patient on hemodialysis.

Diffuse idiopathic skeletal hyperostosis (DISH) is a noninflammatory progressive disease resulting in ossification of the anterior longitudinal ligament of the spine and tendons. Herein, we describe a case of DISH in a patient on long-term hemodialysis. The patient was a 79-year-old man undergoing hemodialysis for chronic kidney disease due to diabetic nephropathy. He presented to the emergency department complaining of back pain after a slip and fall. Radiographs revealed bamboo spine-like findings, extending from the cervical to the lumbar spine. Computed tomography and magnetic resonance imaging revealed a compression fracture of thoracic vertebra 12, with abnormal ossification of the anterior longitudinal ligament. Inter-vertebral vertical osseous bridges were also observed at the cervical 7 and lumbar 2 vertebrae. There was no obvious spinal cord compression. Leukocytosis and C-reactive protein levels were not elevated and the human leukocyte type antigen HLA-B27 test was negative. Based on this finding, a diagnosis of DISH was made. In the absence of neurological findings, the patient was treated conservatively. Our findings show an overlap between the clinical features of DISH and those of hemodialysis patients, including older age, male sex, and diabetes.

The Correlation of Interleukin-6, Malnutrition Inflammation Score and Asymmetric Dimethylarginine in Chronic Kidney Disease Patients Undergoing Routine Hemodialysis

Introduction: Chronic kidney disease (CKD) patients undergoing routine hemodialysis (HD) have a high prevalence of protein-energy malnutrition (PEM) and inflammation. The combination of inflammation and PEM is associated with cardiovascular disease and poor outcomes. Interleukin-6 (IL-6) is an inflammatory factor that runs parallel to endothelial damage and is closely related to the nutritional status of CKD HD patients. The tool to assess nutrition status is Malnutrition Inflammation Score (MIS) and to assess endothelial damage is Asymmetric Dimethylarginine (ADMA). It is currently unclear whether there is a correlation between inflammation, malnutrition, and endothelial dysfunction. Therefore the aim of this study is to determine the correlation between IL-6, MIS and ADMA in CKD HD patients. &#x0D; Methods: A cross-sectional design with analytic observational study was conducted on end stage renal disease patient who undergo routine hemodialysis for at least 2 years with the duration of hemodialysis is 4-5 hours and at least twice per week. IL-6 was examined by kit (ELISA) and ADMA using LC-MS/MS at a certified laboratory in Manado city. History taking and physical examination were used to calculate MIS. Data analysis was done using SPSS version 22.&#x0D; Results: There were 30 participants consisting of 22 men (72%) and 8 women (28%). The median age of the subjects was 56.50 years. There was a statistically significant positive correlation between IL-6 and ADMA (r = 0.440, p = 0.015), MIS and ADMA (r = 0.378, p = 0.039), and IL-6 and MIS (r = 0.682, p = 0.0001).&#x0D; Conclusion: There was a significant correlation between IL-6, MIS and ADMA.

Risk factors associated with 10-year survival after coronary artery bypass grafting

Coronary artery bypass grafting (CABG) is the treatment of choice for a broad spectrum of patients with coronary disease. To describe global survival and factors associated with lower long-term survival in patients operated with isolated CABG. Analysis of a cohort of patients who underwent CABG between January 2006 and December 2008 at a public hospital. The database and operation records of 1.003 cardiac surgeries were reviewed. Of these, an isolated CABG was performed in 658 patients aged 62 ± 9 years including 516 male (78%). Survival data were obtained from the Chilean Civil Registry Office and a complete ten-year follow up was accomplished. Survival was analyzed with Kaplan-Meier method with log-rank test and Cox regression. Operative mortality occurred in 13 patients (2%). Survival at 1, 3, 5 and 10 years was 97, 94, 91 and 76%, respectively. One, 3, 5 and 10-year free of cardiovascular death survival was 98, 97, 95 y 89%, respectively. Factors associated with long-term survival were chronic kidney disease in hemodialysis (Hazard ratio (HR) 7.9; 95% confidence intervals (CI) 4.6-13.6), chronic obstructive pulmonary disease (HR 2.3; 95% CI 1.4-3.7), chronic arterial occlusive disease (HR 2.2; 95% CI 1.4-3.4) and diabetes mellitus (HR 1.9; 95% CI 1.4-2.6). According to EuroSCORE, 10-year survival was 86, 75 and 62% (p < 0.01) in low, medium and high-risk patients, respectively. These patients had a 10-year survival comparable to large international series. Groups associated with lower 10-year survival were identified.

Seek and you shall find—retrieval of a retained fractured intravenous cannula by Z-plasty incision: a case report

Peripheral venous cannulation is a common invasive procedure. Fracture of an intravenous cannula is rare and an under-reported complication of peripheral venous cannulation. Embolization of the intravenous fragment into the central venous system is potentially fatal. Urgent surgical retrieval, which is performed through a transverse or longitudinal incision, is the treatment of choice. We herein present the use of Z-plasty incision for the retrieval of a retained fractured peripheral intravenous cannula in a 61-year-old Nigerian man on hemodialysis for chronic kidney disease. The major benefits of this innovation are facilitation of access for exploration and prevention of joint contracture.

A rare gastric foveolar-type adenoma with lanthanum deposition in a Helicobacter pylori–uninfected patient

A 53-year-old man undergoing hemodialysis for chronic kidney disease had been taking lanthanum carbonate for the previous 3 years. EGD revealed a 5-mm reddish protruding lesion, with a raspberry-like appearance and white deposits on its surface, in the upper third section of the Helicobacter pylori–uninfected stomach (A). Narrow-band imaging (NBI; Olympus, Tokyo, Japan) along with texture and color enhancement imaging (TXI; Olympus)—assisted endoscopy revealed the presence of white deposits considered to be of lanthanum, as confirmed by different endoscopic results from white opaque substance (WOS), light blue crest (LBC), and white globe appearance (WGA) (B, C).

High C-Terminal Fibroblast Growth Factor-23, Intact Parathyroid Hormone, and Interleukin-6 as Determinants of Valvular Calcification in Regular Hemodialysis Patients.

PurposeBiggest cause of death in chronic kidney disease-hemodialysis (CKD-HD) patients is cardiovascular disease (CVD). Cardiovascular disease is often associated with mineral bone disorders (MBD), especially vascular and valvular calcification. Biomarkers such as C-terminal-fibroblast growth factor-23 (FGF-23), intact parathyroid hormone (iPTH), and interleukin-6 (IL-6) were investigated. Only few studies have focused on valvular calcification in CKD-HD patients, with controversial results. The present study aimed to investigate whether high C-terminal-FGF-23, iPTH, and IL-6 can be used as determinants of valvular calcification in CKD-MBD patients undergoing regular HD.Patients and MethodsThis was an analytical cross-sectional study which involved CKD-HD patients aged 18–60 years with no history of CVD, malignancy, and diabetes mellitus. C-terminal FGF-23 was measured using enzyme-linked immunosorbent assay (ELISA) kit, iPTH using chemiluminescent immunometric method, and IL-6 using sandwich enzyme immunoassay technique. Valvular calcification on aortic and mitral valves was examined with echocardiography. Data analysis was done using Chi-squared test or Fisher’s exact test as appropriate and multivariate logistic regression analysis.ResultsBivariate analysis with Fisher’s exact test showed significant association of prevalence ratio (PR) of C-terminal FGF-23 (PR = 1.33; p = 0.003; CI (1.017–1.748)), iPTH (PR = 1.361; p = 0.002; CI (1.02–1.816)), and IL-6 (PR = 1.2; p = 0.019; CI (1.000–1.446)) with valvular calcification. Multivariate analysis with logistic regression showed high C-terminal FGF-23 (exp (B) value of 16.44; p = 0.045; CI (1.07–252.75)), iPTH (exp (B) value of 33.312; p = 0.016; CI (1.94–571.71)), and IL-6 (exp (B) value of 21.58; p = 0.0381; CI (1.18–394.87)) were determinants of valvular calcification in CKD-MBD patients undergoing regular HD.ConclusionThis study demonstrated that high C-terminal FGF-23, iPTH, and IL-6 were determinants of valvular calcification in CKD-MBD patients undergoing regular HD.

The Relationship between Haemodialysis Procedures and Interleukin-6 Levels in Regular Hemodialysis Patients in Haji Adam Malik Central General Hospital

Introduction: Chronic kidney disease (CKD) is kidney damage characterized by the presence of protein in the urine or a decrease in the glomerular filtration rate (GFR). CKD is a global problem throughout the world, including Indonesia, which requires special attention. IL-6 is known to play a role in regulating hemostatic functions, including glucose metabolism, the hypothalamus-pituitary-adrenal (HPA) axis, influencing mood, fatigue, depression, and hematopoiesis. As an inflammatory cytokine, IL-6 is an inflammatory mediator that most plays a role in various conditions, such as infection, autoimmune disease, and cancer. In CKD patients undergoing dialysis (HD), elevated serum IL-6 levels beginning from the start of the treatment is a strong predictor of mortality. The study aimed to determine the association between hemodialysis procedures and interleukin-6 levels in regular hemodialysis CKD patients in Haji Adam Malik Central General Hospital. Methods: This is an analytical study with a cross-sectional design. A total of 20 study subjects met the inclusion criteria and exclusion criteria, underwent history taking, physical examination, anthropometry, and laboratory examination to measure hemoglobin, creatinine, albumin, and IL-6 levels. Data analysis was performed using SPSS. Results: The median level of IL-6 before hemodialysis was 10.39 pg/mL with the lowest level and the highest level being 1.50 – 74.79 pg/mL, the median level of IL-6 after hemodialysis was 29.13 pg/mL with the lowest level and the lowest level. the highest is 2.11 – 316.20 pg/mL. Based on the results of the analysis, the levels of IL-6 after hemodialysis were higher than the levels of IL-6 before hemodialysis, there was a statistically significant relationship between regular hemodialysis and interleukin-6 levels before and after in patients with kidney disease. Conclusion: Regular hemodialysis and interleukin-6 levels have a statistically significant relationship before and after hemodialysis in CKD patients. Keywords: Chronic kidney disease; haemodialysis; interleukin-6.

Protein-Bound Uremic Toxins Induce Reactive Oxygen Species-Dependent and Inflammasome-Mediated IL-1β Production in Kidney Proximal Tubule Cells.

Protein bound-uremic toxins (PBUTs) are not efficiently removed by hemodialysis in chronic kidney disease (CKD) patients and their accumulation leads to various co-morbidities via cellular dysfunction, inflammation and oxidative stress. Moreover, it has been shown that increased intrarenal expression of the NLRP3 receptor and IL-1β are associated with reduced kidney function, suggesting a critical role for the NLRP3 inflammasome in CKD progression. Here, we evaluated the effect of PBUTs on inflammasome-mediated IL-1β production in vitro and in vivo. Exposure of human conditionally immortalized proximal tubule epithelial cells to indoxyl sulfate (IS) and a mixture of anionic PBUTs (UT mix) increased expression levels of NLRP3, caspase-1 and IL-1β, accompanied by a significant increase in IL-1β secretion and caspase-1 activity. Furthermore, IS and UT mix induced the production of intracellular reactive oxygen species, and caspase-1 activity and IL-1β secretion were reduced in the presence of antioxidant N-acetylcysteine. IS and UT mix also induced NF-κB activation as evidenced by p65 nuclear translocation and IL-1β production, which was counteracted by an IKK inhibitor. In vivo, using subtotal nephrectomy CKD rats, a significant increase in total plasma levels of IS and the PBUTs, kynurenic acid and hippuric acid, was found, as well as enhanced urinary malondialdehyde levels. CKD kidney tissue showed an increasing trend in expression of NLRP3 inflammasome components, and a decreasing trend in superoxide dismutase-1 levels. In conclusion, we showed that PBUTs induce inflammasome-mediated IL-1β production in proximal tubule cells via oxidative stress and NF-κB signaling, suggesting their involvement in disease-associated inflammatory processes.

Electrocardiography in post hemodialysed chronic kidney disease patients

Background: Chronic kidney disease (CKD) is associated with higher risk of cardiovascular events and Electrocardiographic changes are common in CKD patients. Electrocardiography (ECG) is cheap and easily available investigation that could pick up abnormalities of heart. Our study focuses on electrocardiographic changes seen within 24 hours in post hemodialysis CKD patients.Methods: It is a cross sectional, observational study of 298 CKD patients who underwent hemodialysis at tertiary care facility of VIMSAR, Burla during the period between November 2018 to November 2020. 12 leads ECG of these patients were taken post hemodialysis and abnormalities were interpreted.Results: Total number of patients included in the study were 298 with mean age distribution of 47±8.4 years. Mean Serum urea level was 126 mg/dl. Creatinine levels ranged between 5-10 mg/dl. Left ventricular hypertrophy (LVH) and left atrial enlargement (LAE) were seen in 14.76% and 8.3% of patients respectively. Atrial fibrillation was present in 4.3% of patients. Left axis deviation (LAD 7%), right axis deviation (RAD 6%), atrial ectopics (2.6%) and tall T waves (7.3%) were the other ECG changes observed.Conclusions: ECG changes are common in CKD patients in post hemodialysis state, so it becomes important to monitor these changes in these patients for early detection of any cardiac abnormalities.

Factors Related to the Presence of Anemia in Patients with Chronic Kidney Disease in Hemodialysis

Introduction: The prevalence of anemia in Chronic Kidney Disease (CKD) is high. However, little is known about the factors related to anemia in patients with chronic Hemodialysis (HD) in Mexico. Material and Methods: A cross-sectional study was conducted in adult patients with CKD undergoing HD in the northern area of Mexico City treated at the Mexican Institute of Social Security. Hemoglobin (Hb) and Hematocrit (Htc) levels, as well as clinical and biochemical factors associated with anemia, were evaluated. Results: Data was collected from 747 patients, obtaining a mean hemoglobin of 9.7 g/dl (IQR 8.4-10.9 g/dl). The group was divided into two using Hb &lt;10.0 g/dl and &gt;10.0 g/dl as cutoff limits. Fifty six percent of the patients had hemoglobin =10.0 g/dl. Hb level &lt;10.0 g/dl were associated with DM (OR 1.49, IC 95% 1.06-2.10, p=0.001), hyperphosphatemia (OR 1.69, IC 95% 1.21-2.28, p=0.001), high calcium-phosphate product (OR 1.43, IC 95% 1.01-2.03, p=0.040) and iron deficiency (OR 1.95, IC 95% 1.38-2.75, p=0.001). Glomerulopathies (OR 0.44, IC 95% 0.22-0.90, p=0.026), female gender (OR 0.55, IC 95% 0.40-0.074, p=0.001) and erythropoietin administration (OR 0.57, IC 95% 0.39-0.82, p=0.002) were associated with hemoglobin ≥10 g/dl. Conclusion: The factors associated with Hb &lt;10.0 g/dl were mineral-bone metabolism disorders and iron deficiency. The periodic evaluation of qualityof- care indicators of HD treatment, such anemia, are necessary to detect improvement opportunities.

Atividade física e qualidade de vida em indivíduos renais crônicos

INTRODUÇÃO: As alterações impostas pela doença renal e por seu tratamento interferem negativamente na qualidade de vida dos indivíduos com doença renal crônica. A atividade física é relatada como uma alternativa terapêutica nesta população, porém, a maioria dos pacientes submetidos à hemodiálise apresentam baixos níveis de atividade física. OBJETIVO: verificar a correlação entre a atividade física e qualidade de vida em indivíduos com doença renal crônica em hemodiálise. MÉTODOS: Este estudo é observacional, analítico, descritivo e quantitativo, desenvolvido em uma das Unidades de Hemodiálise da região Noroeste do Rio Grande do Sul, Brasil, na atenção clínica terciária, durante o período de novembro de 2018 a fevereiro de 2019. Foram incluídos indivíduos maiores de 18 anos e em tratamento hemodialítico por doença renal crônica há mais de três meses; pertencentes ao serviço de hemodiálise. Os critérios de exclusão foram os indivíduos com diagnóstico de doença renal aguda; aqueles que apresentaram aparentemente dificuldades em compreender, responder ou que não realizaram completamente os instrumentos de avaliação propostos (qualidade de vida e pedômetros), indivíduos que no momento da avaliação não apresentaram condições clínicas estáveis. A coleta de dados foi realizada pela análise dos prontuários clínicos e eletrônicos e entrevista semiestruturada. Utilizou-se avaliação pelos pedômetros e pelo questionário Kidney Disease and Quality of Life Short-Form-KDQOL-SFTM. Análises de modelagem por regressão foram realizadas para testar a associação entre o número de passos/dia e os desfechos avaliados RESULTADOS: Foram incluídos na amostra 40 pacientes, destes, 70% são homens, com média de idade de 59,9 ± 13,0 anos. Na correlação entre atividade física e qualidade de vida, o número de passos/dia teve correlação significativa com as dimensões sintomas e problemas (r=0,523;p=0,003), efeitos da doença (r=0,458; p=0,010), função sexual (r=0,361;p=0,050), sono (r=0,357;p=0,049), função física (r=0,617;p=&lt;0,001), papel físico (r=0,504;p=0,004), dor (r=0,496; p=0,005), bem estar emocional (r=0,407; p=0,023), papel emocional (r=0,435;p=0,014), função social (r=0,522;p=0,003), energia/fadiga (r=0,436;p=0,014) e composição física (r=0,598;p=&lt;0,001). As variáveis idade, índice de massa corporal, tempo de hemodiálise e sexo não apresentaram correlação com o número de passos/dia. CONCLUSÃO: Houve correlação positiva entre atividade física e qualidade de vida, ou seja, quanto maior a média de número de passos/dia melhor a qualidade de vida de indivíduos em hemodiálise.

Bilateral external ophthalmoplegia due to uremia in Goodpasture syndrome: A case report

<br>Several ophthalmic manifestations have been reported in patients with uremia due to chronic kidney disease (CKD). These include chronic sore eyes, ischemic optic neuropathy, and retinal detachment. In this case report, we discuss a patient of Goodpasture syndrome undergoing hemodialysis for CKD who presented with a complaint of diplopia. The patient had bilateral near-total external ophthalmoplegia, which initially progressed and remained constant at the last follow-up. The patient was neurologically stable with normal neuroimaging; however, his serum creatinine and blood urea levels remained persistently elevated despite regular hemodialysis. After considering several differential diagnoses, we finally arrived at a diagnosis of bilateral external ophthalmoplegia secondary to uremia and propose potential mechanisms for its pathogenesis.<br>

The effects of an olive-oil massage on hemodialysis patients suffering from fatigue at a hemodialysis unit in southern India- a randomized controlled trial.

To determine the effects that an olive oil massage has on fatigue among patients undergoing hemodialysis, and the associated sociodemographic factors that can reduce fatigue. The study used true experimental pre- and post-test research design. A total of 200 patients were recruited in a selected hemodialysis unit in southern India and were allocated to either a study or control group by randomization, with 100 patients in each group. All the patients in the intervention group were given a lower back and lower leg massage using olive oil at the beginning, and after every hour, of their hemodialysis using olive oil for a period of eight weeks. In contrast, the control group continues to receive routine care. The level of fatigue was measured using the Fatigue Severity Scale both before and after massage therapy. Between 73 and 80% of patients were suffering from severe fatigue and the mean fatigue score was 5.53 (SD 1.82) and 5.56 (SD 1.57) for the study and control group, respectively. After eight weeks of massage therapy, the results showed that 53% of patients in the study group showed borderline fatigue, with a mean score of 4.39 (SD 2.37), whereas in the control group 73% patients showed severe fatigue, with a mean score of 5.17 (SD 2.00). The independent t-test between the study and the control group showed a statistically significant reduction in fatigue in the study group with a mean difference (MD) of 3.56 (t=-1.24; p=0.000). There were also statistically significant changes noted in gender and in the duration of the hemodialysis (χ 2=6.043; p=0.049) and (χ 2=6.611; p=0.046) respectively. The study concluded that patients undergoing hemodialysis experienced moderate to severe levels of fatigue. In patients with no or mild anemia, massage has been shown to decrease fatigue and increase energy levels among patients undergoing hemodialysis for chronic kidney disease.

Institutional cost of the patient with chronic kidney disease managed with hemodialysis.

Chronic kidney disease cost is considered high for health systems due to the amount of supplies required for treatment and increasing prevalence. Determine institutional cost of hemodialysis in chronic kidney disease. Cost design from the institutional perspective, in patients with chronic kidney disease managed with hemodialysis. The sample size was 269 and the sample technique for consecutive cases. Annual fixed average cost (times and movements technique) and annual variable average cost (microcosting technique) adjusted by use of services, helped to identify annual average cost by function of production and service, the sum of these resulted in annual cost of care. Statistical analysis included averages and projections. The average annual cost of the patient with chronic kidney disease on hemodialysis varies between $223,183 and $257,000; the cost in life is $1,198,968. The institutional total cost it corresponds to between 1.47% and 1.73% of the budget. Hemodialysis cost in chronic kidney disease is high for the institution, however, hemodialysis allows the survival of the patient.